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Purpose: To build, train, and assess the artificial neural network (ANN) system in estimating the residual valve rate after endoscopic valve ablation and compare the data obtained with conventional analysis. Methods: In a retrospective cross-sectional study between June 2010 and December 2020, 144 children with a history of posterior urethral valve (PUV) who underwent endoscopic valve ablation were enrolled in the study. MATLAB software was used to design and train the network in a feed-forward backpropagation error adjustment scheme. Preoperative and postoperative data from 101 patients (70%) (training set) were utilized to assess the impact and relative significance of the necessity for repeated ablation. The validated suitably trained ANN was used to predict repeated ablation in the next 33 patients (22.9%) (test set) whose preoperative data were serially input into the system. To assess system accuracy in forecasting the requirement for repeat ablation, projected values were compared to actual outcomes. The likelihood of predicting the residual valve was calculated using a three-layered backpropagating deep ANN using preoperative and postoperative information. Results: Of 144 operated cases, 33 (22.9%) had residual valves and needs to repeated ablation. The ANN accuracy, sensitivity, and specificity for predicting the residual valve were 90.75%, 92.73%, and 73.19%, respectively. Younger age at surgery, hyperechogenicity of the renal parenchyma, presence of vesicoureteral reflux (VUR), and grade of reflux before surgery were among the most significant characteristics that affected postoperative outcome variables, the need for repeated ablation, and were given the highest relative weight by the ANN system. Conclusions: The ANN is an integrated data-gathering tool for analyzing and finding relationships among variables as a complex non-linear statistical model. The results indicate that ANN is a valuable tool for outcome prediction of the residual valve after endoscopic valve ablation in patients with PUV. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to evaluate the effect of coronavirus disease (COVID-19) on the patients' referral in the pregnant population and also investigate each treatment approach's advantages and disadvantages for acute renal colic in pregnancy. Methods: In this retrospective study, we included all pregnant women with ureteral stones referred to a referral center between January 2019 and March 2021. Results: Among 53 pregnant women, 18 (33.9%) were on conservative therapy, which passed the stone without any complications. Double J stent or nephrostomy tube insertion was done for 24 patients (45.2%). Seventeen of these patients (70.8%) presented post-surgical complications, including hematuria (29.2%), pyelonephritis (20.8%), and lower urinary tract symptoms (20.8%). Transurethral lithotripsy (TUL) was done in 11 patients (20.7%). Only one of these patients developed hematuria following TUL. Thus, in our population study, double J stent or nephrostomy insertion was associated with a higher chance of postoperative complications than TUL (p -value = 0.001). Thirty-six patients were referred within 13 months before the entry of COVID-19, while 17 were referred during a similar approximate duration after the COVID-19 entry into the country. Only the initial presentation had a significant difference between these two periods (p -value = 0.034). Conclusions: When conservative treatment fails, we recommend TUL as the second-line treatment over temporary procedures, such as double J stent or nephrostomy insertion. Of note, in a group of patients with an emergent clinical setting, including active infection, deteriorating renal function, signs of preterm labor, solitary kidney, etc., double J or nephrostomy tube insertion remains the preferred management method for its fast resolution of obstruction and infection. Besides, a decrease in visits with an increase in complicated cases after COVID-19 was observed, maybe due to a delay in referring. [ABSTRACT FROM AUTHOR]

Massive goiter with retrosternal extension is most frequently found in the anterior mediastinum; however, 10%-15% of the cases are found in the posterior mediastinum. It may induce symptoms caused by tracheal, esophageal, and recurrent laryngeal nerve compression. Surgery for such a huge mass requires a high degree of experience to avoid serious complications, particularly if it weighs .500 g. Herein, we report the case of a 64-year-old man who complained of neck swelling which was gradually increasing in size during the past 19 years and breathing difficulty that worsened during the past years. A 31 £ 16 cm heterogeneous enhancing mass that expanded the thyroid gland with retrosternal extension, pushing the main vessels posterolaterally and compressing the trachea, was detected during computed tomography of the neck and chest. Total thyroidectomy was performed safely via a transcervical approach. The recovery period was uneventful, and the patient was discharged 5 days later. Given the rarity of a massive goiter that pushes the main vessels and compresses the trachea in the posterior mediastinum, this case report emphasizes the treatment options and outcome of this condition. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to assess the outcome and feasibility of ultrasonography (US)-guided minimally invasive percutaneous nephrolithotomy (mini-PCNL) in children.Materials and Methods: Twenty-five children with upper urinary tract stones who had undergone US-guided mini-PCNL from June 2017 to June 2020 were enrolled in this study. Patients' demographic information and post-treatment results were retrospectively gathered and analysed. Pyelocaliceal system was punctured in prone position using US guidance, and the tract was dilated using single-shot dilation technique. All steps of renal access were done using only US. Mini-PCNL in all cases was done by using 15 Fr rigid nephroscope. Stones were fragmented with a pneumatic lithotripter and evacuated.Results: The patients' mean age was 6.30 ± 3.25 years (range: 1.5-15). The mean stone size was 16.04 ± 3.93 mm (range: 10-30). The mean access time to the stone was 1.50 ± 0.62 min (range: 1-4). The mean operation time was 94.66 ± 3.05 min (range: 90-100 min). The final stone-free rate was 96%. Post-operation fever occurred in 4 (16%) patients who were treated successfully with an antibiotic. No major complications occurred.Conclusions: We recommend US-guided mini-PCNL as a harmless alternative treatment option, in children with renal calculi due to its excellent outcomes and little complications. [ABSTRACT FROM AUTHOR]

Hydatid cyst (HC) disease is a parasitic infection produced by cysts containing the Echinococcus granulosus larval phase. Patients with HC disease are typically asymptomatic until incidentally diagnosed or when complications occur. A rare presentation of liver HC is spontaneous cutaneous fistualisation. We report a 63-year-old female patient admitted in a tertiary care hospital in Ibb, Yemen, in 2019 with an infected cutaneous fistula induced by a ruptured HC. The patient underwent laparotomy and partial cystectomy with excision of the fistula tract. Upon 6-month follow-up, there was no HC recurrence. This report highlights the need for physicians to consider this diagnosis when faced with an unusual cutaneous fistula near organs commonly involved in HC, especially in areas where the prevalence of this disease is high. [ABSTRACT FROM AUTHOR]

Renal oncocytoma is a benign tumor that arises from epithelial cells of the distal renal tubules. It is naturally presented with a small-sized mass, and giant oncocytoma is uncommon. Renal oncocytoma is frequently asymptomatic and challenging to distinguish preoperatively from renal cell carcinoma (RCC). We present a 40-yearold man who presented with intermittent abdominal pain in the last two years. Abdominal computed tomography (CT) scan showed a large, heterogenous left renal mass measured 15 x 16 x 19.5 cm and associated with central calcifications suspected of RCC. The patient underwent a left radical nephrectomy without complication. The histopathological study revealed typical oncocytoma features. There was no detected recurrence or distant metastasis on six months follow-up. In conclusion, it is challenging to distinguish renal oncocytoma from RCC via preoperative radiology images, especially when a giant mass is present. The only histopathology examination of the removed specimen can provide a definitive diagnosis. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate sympathetic skin response (SSR) among patients with Raynaud phenomenon (RP). SSR is a technique for assessment of the damage of peripheral neuropathies and the disorders of the sympathetic system. Methods: Between January 2015 and December 2018, approximately 20 patients with RP and 20 healthy subjects (control group) were recruited from patients referred to the outpatient clinics of Shiraz University of Medical Sciences, Shiraz, Iran. All participants were clinically examined and the SSR was evaluated using a standard protocol. SSR is abnormal when the latency is prolonged and/or the amplitude is reduced. Results: The RP group consisted of 19 women (95%) and one male (5%); three patients (15%) had primary Raynaud's phenomenon (PRP) and 17 patients (85%) had secondary Raynaud's phenomenon. The control group consisted of 16 women (80%) and four males (20%). The mean age of the RP group and control subjects was 43.1 ± 9 and 36.7 ± 8.6 years, respectively. The SSR to the electrical stimulus was absent in three patients with PRP. The total median nerve mean latencies in the upper limb were 1.90 ± 0.57 and 1.19 ± 0.52 seconds for the RP group and control groups, respectively (P <0.001). These findings revealed significantly prolonged SSR latencies in the RP group, while the mean amplitude showed no significant differences in both groups (P = 0.756). Conclusion: Absence or prolonged latency of SSR was associated with the disorders of the unmyelinated axons in the sympathetic system. The findings of the present study suggested the disorders of unmyelinated axons in Raynaud's phenomenon. [ABSTRACT FROM AUTHOR]

Cystic hygroma (CH) is a congenital malformation of the lymphatic system commonly treated with surgical excision. The typical locations of this lesion are the cervico-facial and cervicothoracic region and other rare locations include axilla, mediastinum, and limbs. CH usually presents at birth as a painless mass, which concerns parents. It might also be detected as complications resulting from it, such as respiratory distress fever, a sudden increase in the size, feeding difficulty, and infection. To the best of our knowledge, there are a few cases reported in cervico-axillo- thoracic variants and we reported giant cervico-axillo-thoracic cystic hygroma, which is thoroughly treated with surgical excision. A 45-days female, full-term delivery, infant presented with big right-side trunk mass, diagnosed through computed tomography scan as a CH involving the right lateral and posterior chest wall with extension to the axilla and right side of the neck, which was managed with surgical excision. After a 6-month of follow-up, no recurrent lesion masses were detected. CH is a congenital malformation of the lymphatic system that can be treated in the pediatric population. The treatment option depends on size, age, and location of the lesion. In our case, complete surgical excision was the selective treatment for this lesion. [ABSTRACT FROM AUTHOR]

The electric spring (ES) is a reactive compensator which is series with a noncritical load. This paper utilizes the ES in the distribution networks and examines the underlying performance operationally and economically. A virtual generator model for the electric spring is proposed to ease the study of power systems. An algorithm based on the backward/forward sweep method is proposed for solving the optimal power flow. Then, with a 24‐hour real price and load data of ISO‐NE market, the performance of ES is evaluated operationally and economically in two distribution systems. The ESs may exchange reactive power between each other and this raises active and reactive power losses. To cope this problem, the feeders' voltages of the middle load demand are set as the reference voltages of ESs in each feeder so, each ES has a different reference voltage to cease the ES power exchanges. In this work, indexes such as voltage profile, active power loss, reactive power loss, power factor, electric bill payment, net present value, internal rate of return and the payback year are measured. The results of case study confirm the ES improves power loss, voltage profile, power factor, and stability while it reduces the operation cost. [ABSTRACT FROM AUTHOR]

Persian scholars greatly influenced the advancement of medical sciences during the Middle Ages. As a review of the books surviving from that time shows, infectious diseases was one main field of interest for these scientists. Among this group of health problems, rabies was specifically described by Persian physicians, particularly by Avicenna (980 - 1037 A.D.) in his famous “Canon of Medicine.”The current study aimed to examine these physicians' brilliant views and innovations on the manifestations, diagnosis, and management of rabies, a subject not comprehensively assessed until now. [ABSTRACT FROM AUTHOR]

Purpose: To build, train, and assess the artificial neural network (ANN) system in estimating the residual valve rate after endoscopic valve ablation and compare the data obtained with conventional analysis., Methods: In a retrospective cross-sectional study between June 2010 and December 2020, 144 children with a history of posterior urethral valve (PUV) who underwent endoscopic valve ablation were enrolled in the study. MATLAB software was used to design and train the network in a feed-forward backpropagation error adjustment scheme. Preoperative and postoperative data from 101 patients (70%) (training set) were utilized to assess the impact and relative significance of the necessity for repeated ablation. The validated suitably trained ANN was used to predict repeated ablation in the next 33 patients (22.9%) (test set) whose preoperative data were serially input into the system. To assess system accuracy in forecasting the requirement for repeat ablation, projected values were compared to actual outcomes. The likelihood of predicting the residual valve was calculated using a three-layered backpropagating deep ANN using preoperative and postoperative information., Results: Of 144 operated cases, 33 (22.9%) had residual valves and needs to repeated ablation. The ANN accuracy, sensitivity, and specificity for predicting the residual valve were 90.75%, 92.73%, and 73.19%, respectively. Younger age at surgery, hyperechogenicity of the renal parenchyma, presence of vesicoureteral reflux (VUR), and grade of reflux before surgery were among the most significant characteristics that affected postoperative outcome variables, the need for repeated ablation, and were given the highest relative weight by the ANN system.  Conclusions: The ANN is an integrated data-gathering tool for analyzing and finding relationships among variables as a complex non-linear statistical model. The results indicate that ANN is a valuable tool for outcome prediction of the residual valve after endoscopic valve ablation in patients with PUV.